Objective: To study the therapentic efficacy of using intravascular stent and local thrombolysis for superior vena cava syndrome(SVCS) in cancer patients.
Methods: Among 26 cancer patients with SVCS there were 17 cases of lung cancer with mediastinal lymphnode metastases, 5 cases of malignant mediastinal tumor, 2 cases of non-Hodgkin's lymphomas, 2 cases of esophageal carcinoma with mediastinal lymphnode metastases. Through femoral vein, a catheter with side holes was introduced up to the superior vena cava. Following local dripping of urokinase for 20-40 min, the obstructed region was distended with the inflated balloon and then a self-expanding stent was put in the inflated region.
Results: The procedure was successful in 24 patients, but failed in 2 cases because the guide wire could not pass through the obstructed region. In 3 patients with superior vena cava stenosis of 10 cm in length, two stents were used. In the other 21 patients, 1 stent was adequate. Local thrombolytic treatment was given in 24 patients before the angioplastic balloon was inflated. The vena caval pressure at the distal end of the stenotic lesion dropped from 21.23 +/- 1.80 mm Hg before treatment to 5.33 +/- 0.98 mm Hg after treatment. The difference was statistically significant. Collateral veins were no longer filled by contrast after treatment. The caliber of the supericar vena cava restored to normal and its outline was smooth. The symptoms of SVCS subsided after treatment in 2-3 days.
Conclusion: Intravascular, self-expandable stent combined with local thrombolysis is a micro-invasive and effective method of treatment for cancer patients with superior vena cava syndrome.